Fentanyl is a potent synthetic opioid that is used to treat persistent, chronic pain. Transdermal fentanyl patches attach to the skin to deliver round-the-clock pain treatment. They are typically reserved for people with cancer, terminal illnesses, or chronic pain.

It cannot be understated. Fentanyl is one of the most potent opioid analgesic drugs in the world. It is 50-100 times stronger than heroin. Fentanyl should only be taken under careful medical supervision and prescription. Misusing fentanyl can be fatal. Overdose deaths related to fentanyl were up a staggering 45% in 2017, accounting for more than 28,000 deaths alone.

This article provides an overview of how transdermal fentanyl patches work and highlights the risks and side effects of using fentanyl patches.

Fentanyl Patches

Brand names for fentanyl patches include Duragesic, Matrifen, and Tilofyl. Each patch lasts for approximately 72 hours. Transdermal patches deliver constant, potent opioid medication that is absorbed via the skin. The patches come in four different, transparent sizes beginning at 2.75 mg of fentanyl up to 11.0 mg of fentanyl. The largest application is about four square inches.

Transdermal fentanyl patches include four layers that regulate the delivery of fentanyl in a complex mechanism.

The first layer is a silicon adhesive that attaches directly to the skin.
The second layer is an ethylene-based membrane that controls the rate of fentanyl delivery.
The third layer contains the fentanyl drug and dipropylene glycol mixed with cellulose that allows the fentanyl to be absorbed by the skin.
The fourth layer is a protective, backing sheet of foil that protects fentanyl from leaking out of the controlled, patch membrane.

Fentanyl patches are a sort-of last resort pain management system after other approaches have not worked. They are only prescribed if someone is already opioid-dependent as a result of taking at least 60 mg of morphine, 30 mg of oxycodone, or 8 mg of hydromorphone daily. The risk of a fentanyl overdose is significantly higher for someone who is not already opioid-dependent.

Side Effects of Fentanyl Transdermal Systems

Fentanyl patches are only prescribed to a particular patient who needs relief from moderate to severe, persistent pain that other methods have proven to be ineffective. Some of the side effects of fentanyl patches can range from mild to severe. These symptoms include:

Constipation
Sleepiness
Skin Rash and Irritation

The delivery system can feel like it is burning skin. Other people report intense nausea and vomiting due to the high potency of the drug.

Sleepiness seems like a mild side effect; however, it can be an indicator that the dose of fentanyl is too high. If this is the case, a doctor needs to be contacted immediately. If someone is overly sleepy or has trouble keeping their eyes open while using a fentanyl patch, this can be a serious risk of opioid overdose.

Signs of Fentanyl Overdose

A fentanyl overdose can occur even with the use of doctor-prescribed transdermal fentanyl patches. It is good practice to educate friends and family members for what is called the opioid overdose triad. The overdose triad consists of three key symptoms of onset opiate overdose:

pinpoint pupils
unconsciousness
respiratory depression

Once the overdose process reaches respiratory depression, when someone’s breathing becomes shallow and then stops completely, overdose can become fatal. It can be prudent to keep a prescription of Narcan available in case of emergency.

Narcan, the life-saving emergency opioid overdose medication, delivers naloxone through the nostrils. It instantly alleviates the respiratory depression effects of opioid overdose. We addressed how Narcan works on fentanyl overdoses in greater detail in a previous post.

Children and Fentanyl

Because fentanyl patches are worn and then discarded, young children can be in particular danger. Children being accidentally exposed to fentanyl by incidental exposure by improper storage and disposal have forced the FDA to issue a warning for all fentanyl patients. It is important to store all patches safely out of reach from children. The FDA also suggests fentanyl patches be discarded separately from household trash where children or pets cannot get into it.

Patches can look like stickers or Band-Aids to young children. With their curious minds and desire to mimic their parents, a child may place a patch on their lower back or touch it with their fingers. Even after 72-hour use, there are still traces of the drug left on the adhesive that can cause an overdose in young children.

Store fentanyl in locked rooms or cabinets to ensure children cannot gain access to medication drawers. Take the trash out regularly. It is also good practice to place an adhesive covering over the patch to make sure that no one can accidentally be exposed to the opioid side. While wearing a fentanyl patch, check that the patch is still attached to your skin throughout the day as they can come loose sometimes.